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Cai XY, Lin JH, Huang WC, Wu JC, Chen PY, Chiu HY. Sensory Symptoms and effects on Health-related Quality of Life of Patients Undergoing Lumbar Spine Surgery. Pain Manag Nurs 2022; 24:216-221. [PMID: 36396530 DOI: 10.1016/j.pmn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with lumbar degenerative spine diseases (LDSDs) commonly report sensory symptoms before and after lumbar spine surgery. AIM To explore the changing patterns of sensory symptoms-namely pain, numbness, stinging, itching, and burning-and investigate the influences of sensory symptom changes on the health-related quality of life (HRQoL) of patients who experienced lumbar spine surgery. METHODS All sensory symptoms (i.e., pain, numbness, paresthesia) were measured using a visual analog scale. The Chinese versions of the Oswestry Disability Index, Pittsburgh Sleep Quality Index, Clinically Useful Depression Outcome Scale, and EuroQol-five dimensions (EQ-5D) Scale were used to assess patients 1 week prior to surgery and 6 weeks and 6 months after surgery. A generalized estimating equation was used for data analysis. RESULTS A total of 101 patients with mean age of 58.38 years were included. All sensory symptoms declined significantly over time (all p < .05) with the exception of itching (feeling on toes and thighs). Patients experiencing moderate-to-severe pain had poorer QoL over time, even after controlling for other sensory symptoms and potential confounders. CONCLUSIONS Sensory symptoms gradually declined after surgery, but itching symptom did not. Moderate-to-severe pain was the only sensory symptom that influenced HRQoL over time in patients with LDSDs.
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Affiliation(s)
- Xin-Yi Cai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jiann-Her Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Division of Neurosurgery, Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan.
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Neural Regeneration, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Pin-Yuan Chen
- Department of Neurosurgery, Chang Gung Memorial, Hospital, Keelung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.
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Zachodnik J, Bech‐Azeddine R, Udby PM, Sandberg M, Thybo KH, Geisler A. Postoperative pain treatment after lumbar discectomy. A protocol for a systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiol Scand 2022; 66:288-294. [PMID: 34811726 DOI: 10.1111/aas.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients undergoing lumbar discectomy usually suffer from moderate to severe pain during the postoperative period. Multimodal, or balanced analgesia, is the leading treatment principle for managing postoperative pain. The rationale is to achieve optimal pain treatment through additive or synergistic effects of several non-opioid analgesics, and thereby, reducing the need for postoperative opioids, facilitating early mobilization and functional rehabilitation. For discectomy surgery, evidence of both the benefit and harm of different analgesic interventions is unclear. OBJECTIVES This systematic review aims to investigate the benefits and harms of analgesic interventions in adult patients after lumbar discectomy. METHODS This protocol for a systematic review is written according to The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search The Cochrane Library's CENTRAL, PubMed, EMBASE, and ClinicalTrails.gov for published and ongoing trials. All randomized clinical trials assessing the postoperative analgesics effect of an intervention with a control or no-intervention group undergoing lumbar discectomy will be included. Two authors will independently screen trials for inclusion using Covidence, extract data and assess the risk of bias using Cochrane's risk-of-bias 2 tool. We will analyse the data using Review Manager and Trial Sequential Analysis. Meta-analysis will be performed according to the Cochrane guidelines. We will present our primary findings in a 'summary of findings' table and evaluate the overall certainty of evidence using the GRADE approach. DISCUSSION This systematic review will assess the benefits and harms of analgesic interventions after lumbar discectomy and have the potential to improve best practices and advance research.
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Affiliation(s)
- Josephine Zachodnik
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Zealand Region of Denmark Koege Denmark
| | - Rachid Bech‐Azeddine
- Copenhagen Spine Research Unit (CSRU) Section of Spine Surgery Center of Rheumatology and Spine Diseases Rigshospitalet Denmark
| | - Peter M. Udby
- Department of Orthopedic Surgery Zealand University Hospital Zealand Region of Denmark Koege Denmark
| | - Magnus Sandberg
- Department of Health Sciences Faculty of Medicine Lund University Lund Sweden
| | - Kasper H. Thybo
- Department of Anaesthesiology at the Juliane Marie Centre Copenhagen Denmark
| | - Anja Geisler
- Department of Anaesthesiology Centre for Anaesthesiological Research Zealand University Hospital Zealand Region of Denmark Koege Denmark
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Schaal NK, Assmann A, Rosendahl J, Mayer-Berger W, Icks A, Ullrich S, Lichtenberg A, Akhyari P, Heil M, Ennker J, Albert A. Health-related quality of life after heart surgery - Identification of high-risk patients: A cohort study. Int J Surg 2020; 76:171-177. [PMID: 32169572 DOI: 10.1016/j.ijsu.2020.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/31/2020] [Accepted: 02/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This cohort study evaluated factors, which have been shown to be relevant for Health-Related Quality of Live (HRQL) after cardiac surgery and investigated the combinatory impact on HRQL. Additionally, the aim was to introduce a first attempt to developing a risk estimation model which could identify patients at risk for impaired HRQL. METHODS For this single-centre cohort study, 6099 cardiac surgical patients (60% isolated coronary bypass surgery) filled in the Nottingham Health Profile (NHP) for the evaluation of HRQL six months after surgery and provided information regarding their medical and socio-demographic status. For the NHP scores the deviation to the matched normative data of a healthy sample was calculated. A robust linear regression examined factors that influence HRQL. As a next step, based on the regression model, a risk estimation model was developed which is a first attempt to classify patients into risk categories. RESULTS Male gender, age below 60 or between 60 and 74 years, living alone, no occupation, bypass surgery, NYHA status II, III or IV and chest pain were identified as risk factors to determine impaired HRQL. The model explains 29.13% of the variance. Based on the risk estimation model 27.4% were classified as medium or high risk. CONCLUSIONS For the first time a multilevel method was applied to evaluate HRQL after heart surgery showing that socio-demographic variables are important co-factors to dyspnea and chest pain. We take a first attempt in developing a new approach that should encourage further research in this field to frame a screening tool that may help identifying patients at risk in the future.
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Affiliation(s)
- Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Alexander Assmann
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Artur Lichtenberg
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Martin Heil
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jürgen Ennker
- Department of Cardiac Surgery, HELIOS Klinik, Krefeld, Germany; University of Witten-Herdecke, Witten, Germany
| | - Alexander Albert
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany; Department of Cardiovascular Surgery Klinikum Dortmund GGmbH, Dortmund, Germany
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Trajectory of health-related quality of life and its determinants in patients who underwent lumbar spine surgery: a 1-year longitudinal study. Qual Life Res 2018; 27:2251-2259. [PMID: 29860670 DOI: 10.1007/s11136-018-1888-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of the study was to investigate the trajectory and determinants of changes in health-related quality of life (HRQoL) in the first year after lumbar spine surgery. METHODS A total of 154 consecutive patients who underwent lumbar spine surgery were included in this prospective longitudinal observational study. All participants were asked to complete a battery of questionnaires (Taiwanese version of World Health Organization Quality of Life-BREF, Numerical Rating Scale for leg and back pain, Mandarin Chinese version of the Clinically Useful Depression Outcome Scale, and Chinese version of the Pittsburgh Sleep Quality Index). The Japanese Orthopedic Association score was evaluated by neurosurgeons. The measurement time points were 1 week before and on the first, sixth, and twelfth month after lumbar spinal surgery. A linear mix model was used for data analyses. RESULTS The analyses revealed significant upward trends in HRQoL, particularly in physical health and social relationships during the study period. Patients who aged < 65 years and reported a higher level of functional status experienced a more favorable HRQoL in physical health over time (p = .002 and .02, respectively). Participants who complained of poor sleep quality yielded poorer HRQoL in physical health over time (p = .03). More severe depressive symptom was associated with the poorer HRQoL in social relationships over time (p < .001). CONCLUSIONS To improve the HRQoL, healthcare providers need to pay attention to changes in sleep quality, neurological functions, and depressive symptoms in people receiving lumbar surgery, particularly individuals with increasing age. Concrete interventions and strategies aimed to enhancing HRQoL in these patients are essential.
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Engel-Yeger B, Keren A, Berkovich Y, Sarfaty E, Merom L. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. Disabil Rehabil 2016; 40:302-308. [PMID: 27866425 DOI: 10.1080/09638288.2016.1253114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the role of physical status versus mental status in predicting the quality of life (QOL) of patients with lumbar disk herniation (LDH). METHOD In this correlative study 51 patients with LDH were recruited in their conservative stage of treatment. After profiling their physical status, all participants reported about pain level (according to VAS), pain perception using the Pain Catastrophizing Scale (PCS), and disability level (according to Oswestry Low Back Pain Disability Questionnaire). Their mental status was evaluated using the Spielberger's State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II). Their QOL was evaluated by the World Health Organization Quality of Life Questionnaire, brief version (WHOQOL-BREF). RESULTS Physical status/disability level correlated with anxiety and depression. While Physical status predicted physical QOL, mental status, and mainly anxiety and depression were the significant predictors of psychological, social, and environmental QOL. CONCLUSIONS Mental status may play a significant role in reducing most QOL domains among patients with LDH. The evaluation and intervention process should consider both physical and mental status and their relation to the person's QOL. Since QOL is a major parameter in determining intervention type and success this elaborated perspective may contribute to the intervention planning and outcomes. Implications for rehabilitaion A significant mental distress may accompany the physical disability of patients with LDH. The role of this mental distress in reducing the QOL of patients with LDH may be greater than that of their physical disability. The evaluation and intervention for patients with LDH should refer to both physical and mental status and explore their impacts on quality of life in order to elevate intervention success.
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Affiliation(s)
- Batya Engel-Yeger
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | - Amit Keren
- b Rambam Health Care Campus , Orthopedic Spine Unit , Haifa , Israel
| | - Yaron Berkovich
- b Rambam Health Care Campus , Orthopedic Spine Unit , Haifa , Israel
| | - Elad Sarfaty
- c The Ruth and Bruce Rappaport Faculty of Medicine , Technion , Haifa , Israel
| | - Lior Merom
- b Rambam Health Care Campus , Orthopedic Spine Unit , Haifa , Israel.,d Assuta Medical Center , Haifa , Israel
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Wilson CA, Roffey DM, Chow D, Alkherayf F, Wai EK. A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy. Spine J 2016; 16:1413-1422. [PMID: 27497886 DOI: 10.1016/j.spinee.2016.08.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Sciatica is often caused by a herniated lumbar intervertebral disc. When conservative treatment fails, a lumbar discectomy can be performed. Surgical treatment via lumbar discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. PURPOSE This review aimed to determine preoperative predictors that are associated with postsurgical clinical outcomes in patients undergoing lumbar discectomy. STUDY DESIGN This is a systematic review. METHODS This systematic review of the scientific literature followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE and PubMed were systematically searched through June 2014. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. No financial support was provided for this study. No potential conflict of interest-associated biases were present from any of the authors. RESULTS The search strategy yielded 1,147 studies, of which a total of 40 high-quality studies were included. There were 17 positive predictors, 20 negative predictors, 43 non-significant predictors, and 15 conflicting predictors determined. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical outcomes. CONCLUSIONS It may be possible for certain preoperative factors to be targeted for clinical evaluation by spine surgeons to assess the suitability of patients for lumbar discectomy surgery, the hope being to thereby improve postoperative clinical outcomes. Prospective cohort studies are required to increase the level of evidence with regard to significant predictive factors.
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Affiliation(s)
- Courtney A Wilson
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Darren M Roffey
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada K1Y 4E9
| | - Donald Chow
- Division of Orthopaedic Surgery, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Fahad Alkherayf
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada K1Y 4E9; Division of Neurosurgery, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9
| | - Eugene K Wai
- Ottawa Combined Adult Spinal Surgery Program (OCASSP), The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, ON, Canada K1Y 4E9; Division of Orthopaedic Surgery, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1Y 4E9.
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Change in quality of life, disability, and well-being after decompressive surgery. Int J Rehabil Res 2015; 38:357-63. [DOI: 10.1097/mrr.0000000000000136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Complex coevolution of depression and health-related quality of life in old age. Qual Life Res 2015; 24:2713-22. [PMID: 25986907 DOI: 10.1007/s11136-015-1005-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the coevolution of depression and health-related quality of life (HRQoL) in old age. METHODS In a representative survey of the German general population aged 75 years and older, the course of HRQoL and depression was observed over 4.5 years (3 waves). HRQoL was assessed by the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, while the Geriatric Depression Scale was used to measure depression. A panel vector autoregressive model was used to account for the complex coevolution of depression and HRQoL. Unobserved heterogeneity was taken into account by taking the first differences. RESULTS We revealed a robust negative association between an initial change in HRQoL and a subsequent change in depression score, with substantial sex differences: In women there was a robust association, while in men the significance of this association depended on the model specification. Surprisingly, in the total sample and in both sexes, no robust association between an initial increase in depression and a subsequent change in HRQoL was found. CONCLUSION Findings indicate that the direction of evolution from HRQoL to depression deserves more attention. Furthermore, treatment of depression in late life should aim at improving HRQoL in which remission of depressive symptoms is necessary but not sufficient.
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Schiavolin S, Quintas R, Pagani M, Brock S, Acerbi F, Visintini S, Cusin A, Schiariti M, Broggi M, Ferroli P, Leonardi M. Quality of life, disability, well-being, and coping strategies in patients undergoing neurosurgical procedures: preoperative results in an Italian sample. ScientificWorldJournal 2014; 2014:790387. [PMID: 25538963 PMCID: PMC4235741 DOI: 10.1155/2014/790387] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/03/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this paper is to present the preliminary results of QoL, well-being, disability, and coping strategies of patients before neurosurgical procedure. METHODS We analysed data on preoperative quality of life (EUROHIS-QoL), disability (WHODAS-II), well-being (PGWB-S), coping strategies (Brief COPE), and functional status (KPS score) of a sample of patients with brain tumours and cerebrovascular and spinal degenerative disease admitted to Neurological Institute Carlo Besta. Statistical analysis was performed to illustrate the distribution of sociodemographic and clinical data, to compare mean test scores to the respective normative samples, and to investigate the differences between diagnoses, the correlation between tests, and the predictive power of sociodemographic and clinical variables of QoL. RESULTS 198 patients were included in the study. PGWB-S and EUROHIS-QoL scores were significantly lower than normative population. Patients with spinal diseases reported higher scores in WHODAS-II compared with oncological and cerebrovascular groups. Finally sociodemographic and clinical variables were significant predictors of EUROHIS-QoL, in particular PGWB-S and WHODAS-II. CONCLUSION Our preliminary results show that preoperatory period is critical and the evaluation of coping strategies, quality of life, disability, and well-being is useful to plan tailored intervention and for a better management of each patient.
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Affiliation(s)
- Silvia Schiavolin
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Rui Quintas
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Marco Pagani
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Stefano Brock
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Francesco Acerbi
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Sergio Visintini
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Alberto Cusin
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Marco Schiariti
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Morgan Broggi
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Paolo Ferroli
- Division of Neurosurgery II, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milan, Italy
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Foldemo A, Wärdig R, Bachrach-Lindström M, Edman G, Holmberg T, Lindström T, Valter L, Osby U. Health-related quality of life and metabolic risk in patients with psychosis. Schizophr Res 2014; 152:295-9. [PMID: 24355528 DOI: 10.1016/j.schres.2013.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 11/12/2013] [Accepted: 11/16/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED Improved Health-related quality of life (HRQoL) is an alternative treatment goal for individuals with psychosis, who have up to two times greater prevalence of type 2 diabetes, hypertension and obesity than the general population. AIM to compare HRQoL in patients with psychosis, especially schizophrenia, with a reference sample and explore the relationship between HRQoL and metabolic risk factors in these patients. METHODS a prospective cohort study was carried out in specialized psychiatric outpatient departments in Sweden. The patients were invited consecutively. A prospective population-based study of public health in the south-east of Sweden served as reference group. Patients were assessed with psychiatric questionnaires that included Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the questionnaire EQ5D, both for patients and the population, and several other health status outcomes were used. RESULTS At 73%, schizophrenia and schizoaffective disorder were the most common diagnoses in the patient group. The results in patients (n=903) and population (n=7238) showed significant differences in lower EQ5D among patients. According to the definition by the International Diabetes Federation (IDF), elevated blood pressure was the only metabolic risk associated with lower HRQoL in patients. Raised LDL-cholesterol levels were also significantly related to lower HRQoL. CONCLUSION patients suffering from psychosis had significantly lower HRQoL regarding all components in EQ5D, except for the pain/discomfort component. Almost half of the patient group met the criteria for metabolic syndrome. According to the IDF criteria, elevated blood pressure was the only metabolic risk factor that had an impact on HRQoL.
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Affiliation(s)
- Anniqa Foldemo
- Department of Medical and Health Sciences, Linköping University, Sweden; R&D Department, County Council of Östergötland, Linköping, Sweden.
| | - Rikard Wärdig
- Department of Medical and Health Sciences, Linköping University, Sweden
| | | | - Gunnar Edman
- Department of Molecular Medicine and Surgery, Neurogenetics, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Holmberg
- Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
| | - Torbjörn Lindström
- Department of Medical and Health Sciences, Linköping University, Sweden; Department of Endocrinology, County Council of Östergötland, Linköping, Sweden
| | - Lars Valter
- Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
| | - Urban Osby
- Department of Molecular Medicine and Surgery, Neurogenetics, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
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Lebow R, Parker SL, Adogwa O, Reig A, Cheng J, Bydon A, McGirt MJ. Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc. Neurosurgery 2012. [PMID: 22251975 DOI: 10.1227/neu.0b013e3182302ec3.] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood. OBJECTIVE To assess the effect of microdiscectomy on depression, somatization, and mental well-being in patients with herniated lumbar discs. METHODS Patients undergoing surgical discectomy for single-level, herniated lumbar disc were prospectively evaluated preoperatively, and at 6 weeks and 3, 6, and 12 months postoperatively. Back and leg pain, depression, somatic perception, and mental well-being were assessed. RESULTS One hundred patients were enrolled. All were available for 1-year follow-up. Preoperatively, the visual analog scale for low-back pain (BP-VAS), visual analog scale for leg pain (LP-VAS), Zung Self-Rating Depression Scale (ZUNG), Modified Somatic Perception Questionnaire (MSPQ), and Medical Outcomes Short Form-36 mental component summary scale (SF-36-MCS) were 6.3 ± 2.5, 6.3 ± 2.5, 19 ± 11, 9 ± 7, and 4 ± 14. BP-VAS and LP-VAS significantly improved by 6 weeks. Significant improvement in SF-36-MCS was observed by 6 weeks postoperatively, improvement in MSPQ score was observed 3 months postoperatively, and improvement in the ZUNG depression score was observed 12 months postoperatively. No statistical difference occurred during the remainder of follow-up for any outcome measured once improvement reached statistical significance. Eighteen patients were somatized preoperatively, 67% of which were nonsomatized 1 year postoperatively. Ten patients were clinically depressed preoperatively, 70% of which were nondepressed 1 year postoperatively. Improvement in SF-36-MCS, ZUNG, and MSPQ correlated (P < .001) with improvement in BP-VAS and LP-VAS. CONCLUSION The majority of patients somatized or depressed preoperatively returned to good mental well-being postoperatively. Improvement in pain and overall mental well-being was seen immediately after discectomy. Improvement in somatic anxiety and depression occurred months later. Microdiscectomy significantly improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.
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Affiliation(s)
- Richard Lebow
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Glassman SD, Carreon LY, Anderson PA, Resnick DK. A diagnostic classification for lumbar spine registry development. Spine J 2011; 11:1108-16. [PMID: 22208855 DOI: 10.1016/j.spinee.2011.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 09/25/2011] [Accepted: 11/15/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Low back pain (LBP) is a symptom, not a diagnosis. The failure to differentiate underlying diagnoses in patients complaining of LBP is one of the primary reasons that studies examining treatments for LBP have yielded inconsistent results. To design a lumbar spine registry such that the accumulated data provide applicable guidance for clinical treatment, the incorporation of a functional diagnostic matrix is critical. PURPOSE To propose a clinically relevant diagnostic classification scheme, simple enough for use in clinical practice but granular enough to differentiate characteristics that impact clinical outcome. STUDY DESIGN Case-based development, feasibility, and reliability testing of a classification scheme. PATIENT SAMPLE Thirty case histories were compiled. Each case consisted of a brief clinical history with physical examination findings as well as pertinent radiographic images, including computed tomography scan and magnetic resonance image when available. OUTCOME MEASURES Kappa values for inter- and intrarater reliability. METHODS Thirty-six physicians were asked to provide a three-digit diagnostic code, specifying Symptoms, Structural Pathology, and Compressive Pathology for each case. The cases were then randomly rearranged and sent back to the physicians 2 weeks later for a second review. Inter- and intraobserver reliability was calculated using Randolph's free-marginal multirater kappa. Symptoms are classified differentiating between patients with back or leg pain dominance and those with equal back and leg pain; symptoms are also divided as acute versus chronic. Additional categories denote neurogenic claudication and cauda equina. Structural Pathology includes an option for age appropriate changes. Additional options include disc pathology with and without disc space collapse; spondylolisthesis or spondylolysis without olisthesis; and regional spinal deformity, either scoliosis or kyphosis. The remaining structural categories are primary facet pathology and nonunion after attempted fusion. Compressive Pathology includes a category indicating the absence of any study on which to judge compressive pathology and a category indicating an available study, but the lack of any clinically relevant compressive pathology. Additional options are for either central compression or lateral recess/foraminal/extraforaminal compressive pathology of any etiology. There is also a category for combined central and lateral compression. The final category is recurrent compression, central, lateral, or combined compression after surgical treatment at the involved level. It is important to emphasize that the intention is only to categorize Structural and Compressive Pathology that is relevant to the patient's symptom complex. When more than one relevant structural or compressive lesion exists, the provider should select the most clinically relevant finding. RESULTS The interrater agreement was substantial for Symptoms (κ=0.70) and moderate for Structural Pathology (κ=0.58) and Compressive Pathology (κ=0.53). The intrarater agreement was substantial for Symptoms (κ=0.78), Structural Pathology (κ=0.70), or Compressive Pathology (κ=0.67). CONCLUSIONS This study demonstrates that improved diagnostic stratification of lumbar spine disorders is a feasible goal. The diagnostic coding matrix, based on clinically relevant descriptors, yielded substantial interrater consistency for symptoms, moderate interrater consistency for structural and compressive pathology, and substantial intrarater consistency for all elements.
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Affiliation(s)
- Steven D Glassman
- Norton Leatherman Spine Center, 210 East Gray St., Louisville, KY 40202, USA.
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Walid MS, Robinson ECM, Robinson JS. Higher comorbidity rates in unemployed patients may significantly impact the cost of spine surgery. J Clin Neurosci 2011; 18:640-4. [PMID: 21393000 DOI: 10.1016/j.jocn.2010.08.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 11/25/2022]
Abstract
Chronic back pain is commonly associated with physical and mental comorbidities, which create a considerable burden on the healthcare system. We examined the differences in comorbidity rates of 619 spinal surgery patients of employment age, and the impact of comorbidity rates on length of hospital stay and cost. The charts of patients aged >25 years and <65 years were reviewed retrospectively. Type of surgery, employment status, comorbidities, length of stay and hospital charges were studied using chi-square, Fisher, Student's t-test, Wilcoxon-Mann-Whitney test and multivariate analysis. The unemployment rate among employment-aged spinal surgery patients was 44.7%. Unemployed patients who underwent any of the three types of surgery (anterior cervical decompression and fusion, lumbar decompression and fusion, and lumbar microdiscectomy [LMD]) stayed longer in hospital but had higher hospital charges in the minimally invasive LMD group only. There were higher rates of some comorbidities in unemployed compared to employed patients: asthma (12.2% vs. 5.9%), coronary artery disease (20.4% vs. 12.8%), diabetes mellitus (58.0% vs. 47.3%), history of coronary artery bypass surgery or stent placement (18.2% vs. 11.6%), hypothyroidism (14.4% vs. 8.2%), knee joint disease (43.1% vs. 33.6%), chronic renal disease (12.9% vs. 2.9%) and opioid (55.2% vs. 45.9%) antidepressant (37.0% vs. 25.3%) anxiolytic (16.0% vs. 8.9%) use. Charlson comorbidity scores were significantly different (p<0.001) between unemployed (1.72 ± 1.90) and employed patients (1.03 ± 1.55). Multivariate analysis showed that a history of coronary artery bypass/stent procedure, chronic renal disease or preoperative opioid use had a significant impact on length of stay and hospital charges in unemployed spine surgery patients. Thus, unemployment in spinal surgery candidates is associated with higher comorbidity rates with a significant impact on healthcare cost. More research is needed into the relationship between unemployment and consumption of healthcare resources.
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Affiliation(s)
- Mohammad Sami Walid
- Medical Center of Central Georgia, 840 Pine Street, Suite 950, Macon, Georgia 31201, USA.
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Lebow R, Parker SL, Adogwa O, Reig A, Cheng J, Bydon A, McGirt MJ. Microdiscectomy Improves Pain-Associated Depression, Somatic Anxiety, and Mental Well-Being in Patients With Herniated Lumbar Disc. Neurosurgery 2011; 70:306-11; discussion 311. [PMID: 22251975 DOI: 10.1227/neu.0b013e3182302ec3] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood.
OBJECTIVE:
To assess the effect of microdiscectomy on depression, somatization, and mental well-being in patients with herniated lumbar discs.
METHODS:
Patients undergoing surgical discectomy for single-level, herniated lumbar disc were prospectively evaluated preoperatively, and at 6 weeks and 3, 6, and 12 months postoperatively. Back and leg pain, depression, somatic perception, and mental well-being were assessed.
RESULTS:
One hundred patients were enrolled. All were available for 1-year follow-up. Preoperatively, the visual analog scale for low-back pain (BP-VAS), visual analog scale for leg pain (LP-VAS), Zung Self-Rating Depression Scale (ZUNG), Modified Somatic Perception Questionnaire (MSPQ), and Medical Outcomes Short Form-36 mental component summary scale (SF-36-MCS) were 6.3 ± 2.5, 6.3 ± 2.5, 19 ± 11, 9 ± 7, and 4 ± 14. BP-VAS and LP-VAS significantly improved by 6 weeks. Significant improvement in SF-36-MCS was observed by 6 weeks postoperatively, improvement in MSPQ score was observed 3 months postoperatively, and improvement in the ZUNG depression score was observed 12 months postoperatively. No statistical difference occurred during the remainder of follow-up for any outcome measured once improvement reached statistical significance. Eighteen patients were somatized preoperatively, 67% of which were nonsomatized 1 year postoperatively. Ten patients were clinically depressed preoperatively, 70% of which were nondepressed 1 year postoperatively. Improvement in SF-36-MCS, ZUNG, and MSPQ correlated (P < .001) with improvement in BP-VAS and LP-VAS.
CONCLUSION:
The majority of patients somatized or depressed preoperatively returned to good mental well-being postoperatively. Improvement in pain and overall mental well-being was seen immediately after discectomy. Improvement in somatic anxiety and depression occurred months later. Microdiscectomy significantly improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.
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Affiliation(s)
- Richard Lebow
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L. Parker
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Owoicho Adogwa
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam Reig
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph Cheng
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ali Bydon
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Matthew J. McGirt
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Silverplats K, Lind B, Zoega B, Halldin K, Gellerstedt M, Rutberg L, Brisby H. Health-related quality of life in patients with surgically treated lumbar disc herniation: 2- and 7-year follow-up of 117 patients. Acta Orthop 2011; 82:198-203. [PMID: 21434763 PMCID: PMC3235291 DOI: 10.3109/17453674.2011.566136] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Health-related quality of life (HRQoL) instruments have been of increasing interest for evaluation of medical treatments over the past 10-15 years. In this prospective, long-term follow-up study we investigated the influence of preoperative factors and the change in HRQoL over time after lumbar disc herniation surgery. METHODS 117 patients surgically treated for lumbar disc herniation (L4-L5 or L5-S1) were evaluated with a self-completion HRQoL instrument (EQ-5D) preoperatively, after 2 years (96 patients) and after 7 years (89 patients). Baseline data (age, sex, duration of leg pain, surgical level) and degree of leg and back pain (VAS) were obtained preoperatively. The mean age was 39 (18-66) years, 54% were men, and the surgical level was L5-S1 in 58% of the patients. The change in EQ-5D score at the 2-year follow-up was analyzed by testing for correlation and by using a multiple regression model including all baseline factors (age, sex, duration of pain, degree of leg and back pain, and baseline EQ-5D score) as potential predictors. RESULTS 85% of the patients reported improvement in EQ-5D two years after surgery and this result remained at the long-term follow-up. The mean difference (change) between the preoperative EQ-5D score and the 2-year and 7-year scores was 0.59 (p < 0.001) and 0.62 (p < 0.001), respectively. However, the HRQoL for this patient group did not reach the mean level of previously reported values for a normal population of the same age range at any of the follow-ups. The changes in EQ-5D score between the 2- and 7-year follow-ups were not statistically significant (mean change 0.03, p = 0.2). There was a correlation between baseline leg pain and the change in EQ-5D at the 2-year (r = 0.33, p = 0.002) and 7-year follow-up (r = 0.23, p = 0.04). However, when using regression analysis the only statistically significant predictor for change in EQ-5D was baseline EQ-5D score. INTERPRETATION Our findings suggest that HRQoL (as measured by EQ-5D) improved 2 years after lumbar disc herniation surgery, but there was no further improvement after 5 more years. Low quality of life and severe leg pain at baseline are important predictors of improvement in quality of life after lumbar disc herniation surgery.
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Affiliation(s)
- Katarina Silverplats
- Department of Orthopaedics, Sahlgrenska University Hospital and Institute for Clinical Sciences, University of Gothenburg, Gothenburg
| | - Bengt Lind
- Gothenburg Spine Center, Gothenburg, Sweden
| | - Björn Zoega
- Landspitali University Hospital, Reykjavik, Iceland
| | - Klas Halldin
- Department of Orthopaedics, Sahlgrenska University Hospital and Institute for Clinical Sciences, University of Gothenburg, Gothenburg
| | | | - Lena Rutberg
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Helena Brisby
- Department of Orthopaedics, Sahlgrenska University Hospital and Institute for Clinical Sciences, University of Gothenburg, Gothenburg
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Liu WG, Wu XT, Guo JH, Zhuang SY, Teng GJ. Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy. Cardiovasc Intervent Radiol 2009; 33:780-6. [PMID: 19830485 DOI: 10.1007/s00270-009-9720-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 09/14/2009] [Indexed: 10/20/2022]
Abstract
We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 +/- 0.67 years and 6.42 +/- 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications, hospitalization duration, and costs in PLD group are also lower.
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Affiliation(s)
- Wen-Gui Liu
- Department of Radiology, Zhong-Da Hospital, Southeast University, 87 Ding Jia Qiao Road, 210009 Nanjing, China
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